Bipolar disorder, also known as manic-depressive illness, is a disorder that causes unusual shifts in a individual's mood, energy, and ability to function. Different from the normal ups and downs that people experience, the symptoms of bipolar disorder are generally severe. They can result in damaged relationships, poor job or school performance, and even suicide.
Bipolar disorder typically develops in late adolescence or early adulthood. However, some people have their first symptoms during childhood, and some develop them late in life. Bipolar disorder is a long-term illness that usually requires management throughout an individual's life.
Bipolar disorder typically causes dramatic mood swings, from overly elated (“high”) and/or irritable to sad and hopeless, and then back again, often with periods of normal mood in between. Severe changes in energy and behavior oftentimes are experienced with these changes in mood. The periods of highs and lows are referred to as episodes of mania and depression.
Signs and symptoms of mania (or a manic episode) may include the following: increased energy, activity, and restlessness; excessively “high,” overly good, euphoric mood; extreme irritability; racing thoughts and talking very fast, jumping from one idea to another; distractibility (e.g., difficulty concentrating); decreased need for sleep; unrealistic belief in one's abilities and powers; poor judgment; spending sprees; a lasting period of behavior that is different from usual; increased sexual drive; abuse of drugs (particularly cocaine, alcohol, and sleeping medications); and provocative, intrusive, or aggressive behavior. A manic episode may be diagnosed if elevated mood occurs with three or more of the other symptoms most of the day, nearly every day, for one week or longer.
Signs and symptoms of depression (or a depressive episode) may include the following: lasting sad, anxious, or empty mood; feelings of hopelessness or pessimism; feelings of guilt, worthlessness, or helplessness; loss of interest or pleasure in activities once enjoyed; decreased energy, a feeling of fatigue or of being “slowed down”; difficulty concentrating, remembering, or making decisions; restlessness or irritability; sleeping too much, or difficulty sleeping; change in appetite and/or unintended weight loss or gain; chronic pain or other persistent bodily symptoms that are not caused by physical illness or injury; and thoughts of death or suicide, or suicide attempts. A depressive episode may be diagnosed if five or more of these symptoms last most of the day, nearly every day, for a period of two weeks or longer.
A mild to moderate level of mania is generally referred to as hypomania. Hypomania may feel good to the individual who experiences it and may even be associated with good functioning and enhanced productivity. Thus, even when family and friends learn to recognize the mood swings as possible bipolar disorder, the individual may deny that anything is wrong. Without proper treatment, however, hypomania can become severe mania or can switch into depression.
Sometimes severe episodes of mania or depression include symptoms of psychosis. Common psychotic symptoms are hallucinations (hearing, seeing, or otherwise sensing the presence of things not actually there) and delusions (false, strongly held beliefs not influenced by logical reasoning or explained by an individual's usual cultural concepts). Psychotic symptoms in bipolar disorder tend to reflect the extreme mood state at the time. For example, delusions of grandiosity, such as believing one is the President or has special powers or wealth, may occur during mania; delusions of guilt or worthlessness, such as believing that one is ruined and penniless or has committed some terrible crime, may appear during depression.
It may be helpful to think of the various mood states in bipolar disorder as a spectrum or continuous range. At one end is severe depression, above which is moderate depression and then mild low mood, which many people call “the blues” when it is short-lived but is termed “dysthymia” when it is chronic. Then there is normal or balanced mood, above which comes hypomania (mild to moderate mania), and then severe mania.
In some people, however, symptoms of mania and depression may occur together in what is called a mixed bipolar state. Symptoms of a mixed state often include agitation, trouble sleeping, a significant change in appetite, psychosis, and suicidal thinking. An individual may have a very sad, hopeless mood while at the same time feeling extremely energized.
Bipolar disorder may also initially present as a problem other than mental illness. For instance, it may surface as alcohol or drug abuse, poor school or work performance, or strained interpersonal relationships. Such problems in fact may be signs of an underlying bipolar disorder.
The classic form of the illness, which involves recurrent episodes of mania and depression, is called bipolar I disorder. Some individuals, however, never develop severe mania but instead experience milder episodes of hypomania that alternate with depression; this form of the illness is called bipolar II disorder. When four or more episodes of illness occur within a 12-month period, an individual is said to have rapid-cycling bipolar disorder. Some individuals experience multiple episodes within a single week, or even within a single day.
Bipolar disorder may be treated with medication and psychosocial therapy. For example, medications known as mood stabilizers may be prescribed. In general, individuals with bipolar disorder continue treatment with mood stabilizers for years. Other medications may be added when necessary, typically for shorter periods, to treat episodes of mania or depression that break through despite the mood stabilizer.
However, despite the use of mood stabilizers, drugs, e.g., alcohol, prescription drugs, or other illicit drugs, are often used as a form of “self-medication” in order to counteract unpleasant psychological symptoms (such as racing thoughts), which often leads to abuse of these drugs. Patients with bipolar disorder and other psychiatric disorders may also demonstrate somatization and therefore seek out “pain management” doctors, because the analgesics, hypnotics and stimulants commonly prescribed in this context can help to temporarily relieve or control dysphoric symptoms experienced in part as physical pain.
The high rates of drug abuse amongst patients with psychiatric disorders has been documented. See, e.g., Cerullo and Strakowski, Subst Abuse Treat Prev Policy (2007) 2:29. For example, Cerullo and Strakowski report that the lifetime history of any drug abuse or dependence is 84% for anti-social personality disorder, 62% for bipolar disorder types I and II, and 47% for schizophrenia, compared with 27.2% for major depressive disorder and 17% for the general population.
However, drug abuse, e.g., opioid abuse, and opioid withdrawal, can actually worsen mood symptoms and significantly complicate the course and prognosis of bipolar disorder or any other psychiatric illness, resulting in increased suffering, disability, and costs through more frequent and prolonged affective episodes, decreased compliance with treatment, a lower quality of life, and increased suicidal behavior.
Accordingly, new regimens for treating unpleasant and/or difficult to treat symptoms of psychiatric disorders, especially bipolar disorder would be useful. Treatment regimens that address drug abuse and withdrawal, e.g., opioid abuse and withdrawal, would also be useful. In particular, treatment regimens that are provided as kits would be desirable.